2017-02-09T19:05:31-06:00 2016-03-31 460403496 CASEY PETERSON LTD 909 ST JOSEPH ST SUITE 101 RAPID CITY SD 57701 990 2015-04-01 450340688 WEST RIVER HEALTH SERVICES WEST 7015674561 1000 HIGHWAY 12 HETTINGER ND 58639 Nathan Stadheim CFO 7015674561 2017-02-09 1 DEIDRE BUDAHL CPA P01273830 6053481930 2017-02-09 2015 2021-01-29 14:40:06Z West River Regional Medical Center JIM K LONG 1000 HIGHWAY 12 HETTINGER ND 58639 27095917 0 X www.wrhs.com X 1977 ND PROVIDE COMPREHENSIVE HEALTH AND WELLNESS SERVICES TO THE RESIDENTS AND VISITORS OF THE REGION. 11 9 317 0 0 0 342674 767473 25501080 26253351 49333 20186 48267 50803 25941354 27091813 0 0 0 0 10971511 11573420 0 0 88467 14721674 15895141 25693185 27468561 248169 -376748 28350896 27279283 8596544 7424004 19754352 19855279 X THE MISSION OF WEST RIVER HEALTH SERVICES (WRHS) IS TO PROVIDE COMPREHENSIVE HEALTH AND WELLNESS SERVICES TO THE RESIDENTS AND VISITORS OF THE REGION. 0 0 23232553 26254729 WEST RIVER HEALTH SERVICES (WRHS) IS A NATIONALLY-RECOGNIZED RURAL HEALTH CARE DELIVERY SYSTEM INCLUDING HOSPITAL, SWING BED, SURGERY, LAB, RADIOLOGY, EMERGENCY ROOM, SEVEN CLINICS, EYE CLINIC, VISITING NURSE SERVICES, AMBULANCE SERVICE, FAMILY THERAPY, REHABILITATIVE THERAPIES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SPEECH THERAPY, HOME MEDICAL EQUIPMENT STORE, AND WELLNESS/FITNESS SERVICES.IN FY 2016 WRHS PROVIDED ACUTE CARE SERVICES TO 804 PATIENTS FOR A TOTAL OF 2,855 DAYS OF CARE. SWING BED SERVICES WERE PROVIDED TO 93 PATIENTS FOR A TOTAL OF 697 DAYS OF CARE. IN ADDITION, 424 DAYS OF OBSERVATION CARE WERE PROVIDED. THERE WERE 1,682 EMERGENCY ROOM VISITS DURING THE YEAR. THERE WERE 88 BABIES BORN DURING THE YEAR WITH A TOTAL OF 186 DAYS OF CARE PROVIDED. THERE WERE A TOTAL OF 825 SURGICAL CASES DURING THE YEAR, WITH 716 OF THOSE BEING DONE ON AN OUTPATIENT BASIS. THE AMBULANCE CREW MADE 247 AMBULANCE RUNS/TRANSFERS THROUGHOUT THE YEAR. THERE WERE 47,086 CLINIC ENCOUNTERS TO THE SEVEN CLINICS. ANCILLARY SERVICES WERE PROVIDED AS FOLLOWS: 196,322 LAB TESTS; 8,626 RADIOLOGY TESTS; 10,485 RESPIRATORY THERAPY PROCEDURES; 31,420 MEALS TO PATIENTS, VISITORS, AND EMPLOYEES. THROUGHOUT THE YEAR THERE WERE 1,798 RHC NURSE VISITS. 23232553 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 50 0 1 317 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X NATHAN STADHEIM 7015674561 1000 HIGHWAY 12 HETTINGER ND 58639 GARY DEWHIRST VICE CHAIRMAN 1.00 X X 170 0 0 JONATHON EATON sECRETARY/TREASURER 1.00 X X 150 0 0 HALEY EVANS Past Chairman 1.00 X 50 0 0 LARRY JACKSON BOARD MEMBER 1.00 X 130 0 0 CODY JORGENSON cHAIRMAN 11.00 X X 320 0 0 ERVIN SCHNEIDER BOARD MEMBER 1.00 X 120 0 0 CLEVE TESKE BOARD MEMBER 1.00 X 210 0 0 ANTHONY LARSON BOARD MEMBER 1.00 X 20 0 0 DR GERALD SAILER BOARD MEMBER 2.00 X 160 0 0 DR JOSH RANUM MEDICAL STAFF LIAISON 1.00 X 0 0 0 GWYNNE SMITH BOARD MEMBER 1.00 X 20 0 0 JIM LONG CEO (Former) 36.00 4.00 X 163523 0 21400 NATHAN STADHEIM CFO 32.00 8.00 X 91189 0 18263 MITCH SCHULTZ PHARMACIST 40.00 X 125000 0 20397 CAROL CORNELIUS PHARMACIST 40.00 X 112856 0 18591 TERESA NIELSEN PHYSICIAN ASSISTANT/CLINIC MANAGER 40.00 X 107758 0 17780 TERRY ANDERSON CNO 40.00 X 106322 0 8867 DAVID MUGGERUD Respiratory THerapist 40.00 X 106908 0 16580 814906 0 121878 6 0 1 0 UNITED CLINICS PHYSICIANS PC 110 HWY 12 HETTINGER ND 58639 PHYSICIAN SERVICES 4555868 Ainsworth-Benning Construction 345 Industrial Dr Spearfish SD 57783 CONSTRUCTION SERVICES 1505307 DR MARK KRISTY 1000 HWY 12 HETTINGER ND 58639 PROFESSIONAL RADIOLOGY SERVICES 372625 CHRISTENSEN ANEsTHESIA INC 802 11TH AVE NW HETTINGER ND 58639 PROFESSIONAL ANESthetist SERVICES 183522 ALEX OR KATHLEEN THOMPSON PO BOX 1058 HETTINGER ND 58639 PHYSICAL THERAPY SERVICES 159940 5 536683 230790 767473 PATIENT SERVICE REVENUE 621110 25697164 25697164 OTHER 900099 287127 287127 Assisted Living 623000 99775 99775 CAFETERIA 722210 94285 94285 AFFILIATION SUPPORT 900099 75000 75000 26253351 18808 18808 52830 2027 50803 50803 50803 3455 0 2077 3455 -2077 1378 1378 27091813 26254729 0 69611 X 233284 233284 9238327 6982975 2166885 88467 320461 261176 59285 1109768 904461 205307 671580 547338 124242 57182 57182 47210 47210 6681288 6484874 196414 97323 97323 54796 44659 10137 503700 410516 93184 144657 111990 32667 49779 31907 17872 225464 225464 1943529 1583976 359553 230086 192741 37345 MEDICAL SUPPLIES 3418990 3292380 126610 BAD DEBTS 1224756 1224756 REPAIRS & MAINTENANCE 726068 591745 134323 RECRUITMENT 259764 191404 68360 230549 150191 80358 27468561 23232553 4147541 88467 5021481 3240708 5756120 4513408 661650 679677 236261 296838 37637128 22718498 13113142 14918630 2551831 2563859 1010411 1066163 28350896 27279283 3148569 2007817 30348 286348 4544454 4379818 873173 750021 8596544 7424004 X 19754352 19855279 19754352 19855279 28350896 27279283 -376748 1377 476298 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 6103 16163 11193 11073 0 18000 90113 108113 1941458 18760168 10505664 10195962 30107 16071699 11788276 4313530 725583 424558 301025 14918630 X 25870458 1377 -1224756 -1223379 27093837 -2024 -2024 27091813 26245832 2027 2027 26243805 1224756 1224756 27468561 Part IV, Line 1b: THE HOSPITAL HAS AN AUXILIARY THAT OPERATES UNDER THEIR EIN. THESE FUNDS ARE CONTROLLED BY THE AUXILIARY BOARD MEMBERS. Part X, Line 2: WEST RIVER HEALTH SERVICES (WRHS) IS ORGANIZED AS A NORTH DAKOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE 501(C)(3). WRHS IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. WRHS BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. WRHS WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. Part XI, Line 2d - Other Adjustments: BAD DEBTS -624,756. Related Party Receivables Impairment -600,000. Part XI, Line 4b - Other Adjustments: RENTAL EXPENSES -2,027. Round variance 3. Part XII, Line 2d - Other Adjustments: RENTAL EXPENSES 2,027. Part XII, Line 4b - Other Adjustments: BAD DEBTS 624,756. Related Party Receivables Impairment 600,000. PART XI LINE 2D BAD DEBTS ARE NETTED AGAINST REVENUE FOR FINANCIAL STATEMENT PURPOSES, HOWEVER, THEY ARE INCLUDED IN THE FUNCTIONAL EXPENSES FOR THE 990 PRESENTATION. PART XI LINE 4B EXPENSES RELATED TO RENTAL PROPERTY IS INCLUDED IN EXPENSES FOR PURPOSES OF THE AUDITED FINANCIAL STATEMENTS, HOWEVER, THESE EXPENSES ARE NETTED AGAINST THE GROSS RENT IN REVENUE FOR 990 PRESENTATION. PART XII LINE 2D RENTAL EXPENSES ARE NETTED AGAINST THE GROSS RENT REVENUE FOR PURPOSES OF THE 990, BUT ARE REPORTED IN EXPENSES IN THE AUDITED FINANCIAL STATEMENTS. PART XII LINE 4B BAD DEBTS ARE INCLUDED IN THE FUNCTIONAL EXPENSE ALLOCATION FOR PURPOSES OF THE 990, HOWEVER, THEY ARE NETTED AGAINST REVENUES FOR FINANCIAL STATEMENT PURPOSES. 1 1 X 1 X 1 X 0 1 0 0 115060 115060 0.00440 475287 364771 110516 0.00420 590347 364771 225576 0.00860 31357 11550 19807 0.00080 1246716 1017830 228886 0.00870 1278073 1029380 248693 0.00950 1868420 1394151 474269 0.01810 9544 9544 0.00040 209758 209758 0.00800 219302 219302 0.00840 1 624756 12180135 12847028 -666893 X 1 1 1 1 WEST RIVER HEALTH SERVICES 1000 HIGHWAY 12 HETTINGER ND 58639 WRHS.COM X X X X X CLINIC & 5 RHC'S - ALL PROVIDER BASED WEST RIVER HEALTH SERVICES 1 0 0 1 X X X X X X X 14 1 0 0 1 X HTTP://WWW.WRHS.COM X 1 14 1 HTTP://WWW.WRHS.COM 0 0 1 X 100.000000000000 200.000000000000 1 1 X X X 1 X WRHS.COM X wrhs.com X wrhs.com X X X X 1 X X 0 X X X X 1 X 0 0 WEST RIVER HEALTH SERVICES Part V, Section B, Line 5: WEST RIVER HEALTH SERVICES CONTRACTED TO HAVE THE CHNA PERFORMED. THE CONTRACTOR HAD PARTICIPATION FROM THE FOLLOWING GROUPS: BOARDS OF DIRECTORS OF THE HEALTH SYSTEM, INDEPENDENT HEALTH PROVIDERS, EMERGENCY MEDICAL SYSTEM PERSONNEL, FITNESS PROVIDERS, HOSPICE AND HOME CARE PROVIDERS, QUALITY MANAGMENT PERSONNEL, ECONOMIC DEVELOPMENT LEADERS, LONG TERM CARE PROVIDERS, PRIMARY CARE PROVIDERS, POLITICAL LEADERS, EDUCATIONAL REPRESENTATIVE, PUBLIC HEALTH AND SOCIAL SERVICES PROVIDERS, CLERGY REPRESENTATIVES, AND PHARMACISTS. WEST RIVER HEALTH SERVICES Part V, Section B, Line 11: The top three needs identified in the most recent CHNA were: 1) access to a comprehensive range mental health services, 2) Increase the community's commitment to healthy lifestyles, 3) Provide local availability to more specialized services such as minimally invasive surgery. WRHS plans to hire a Licensed Clinical Social Worker and is researching telehealth options to provide our patients with a more comprehensive range of mental health services. Both of these items are planned for completion in the next couple of years. The Community Wellness Coordinator along with many other WRHS staff members continue to provide community members opportunities to take an active role in their health. This is accomplished through monthly radio spots on healthy living, participation in community groups aimed at increasing access to exercise facilities and continued operation of the wellness center despite financial burden. Recruitment of new providers is a continued focus of WRHS. The residency program started in July 2015. Studies have proven that physicians are more likely to practice in an area closer in proximity to where their residencies were completed. In addition, the Physician Recruitment Committee continues to evaluate any potential leads on surgical candidates. In addition to the full-time providers, WRHS invites specialists from the more urban areas to spend a limited amount of time in one or more of our rural locations to allow more comprehensive care, closer to the patients' homes. 2 1 - WEST RIVER EYE CENTER 1000 HWY 12 HETTINGER ND 58639 CLINIC 2 - WEST RIVER FOOt & ANKLE CENTER 683 STATE AVENUE SUITE E DICKINSON ND 58601 CLINIC Part I, Ln 7 Col(f): The bad debt expense is greater on the 990 than the financials because of related party bad debt expense. Part II, Community Building Activities: WEST RIVER HEALTH SERVICES IS A NOT-FOR-PROFIT ORGANIZATION WHOSE MISSION IS TO PROVIDE COMPREHENSIVE HEATLH AND WELLNESS SERVICES TO RESIDENTS AND VISITORS OF THE REGION. WE DO THIS BY REINVESTING OUR PROFITS BACK INTO THE COMMUNITIES THROUGH VARIOUS PROGRAMS AND SERVICES; MAKING SURE THAT CARE IS AVAILABLE TO EVERYONE REGARDLESS OF ABILITY TO PAY; OFFERING CARE WITH COMPASSION TO ALL PATIENTS; AND PROVIDING A WIDE RANGE OF SPECIAL BENEFITS TO EACH COMMUNITY, SUCH AS PROGRAMS TO MANAGE CARE FOR PERSONS WITH CHRONIC DISEASES, HEALTH EDUCATION AND DISEASE PREVENTION INITIATVES, OUTREACH FOR THE ELDERLY, AND CARE FOR PERSONS WHO ARE POOR OR UNINSURED.WEST RIVER HEALTH SERVICES WORKS WITH MANY COMMUNITY PROGRAMS EACH YEAR, OFTEN PARTNERING WITH OTHER ORGANIZATIONS THROUGHOUT THE SERVICE AREA. THE ORGANIZATION WAS INSTRUMENTAL IN THE APPLICATION TO AND AWARD OF A SOUTHWESTERN AREA HEALTHCARE EDUCATION CONSORTIUM, AN OUTREACH EFFORT ENCOMPASSING THE WESTERN HALF OF NORTH DAKOTA. THE GOAL OF THE SWAHEC IS TO ASSIST HEALTH CARE PROVIDERS IN THEIR RECUITMENT AND RETENTION OF HEALTH CARE WORKERS THROUGHOUT WESTERN NORTH DAKOTA. QUITE THE CONTRAST TO OTHER PARTS OF THE NATION, NORTH DAKOTA IS FACING SEVERE SHORTAGE OF WORKERS IN MANY INDUSTRIES, INCLUDING HEALTH CARE. MEMBERS FROM THE MANAGEMENT TEAM STAY CONNECTED TO THE COMMUNITIES THROUGH THEIR INVOLVEMENT WITH OTHER COMMUNITY ORGANIZATIONS, INCLUDING MEMBERSHIP ON NUMEROUS COMMUNITY BOARDS AND COMMITTEES. DOING SO GIVES THE ORGANIZATION A VOICE AND INPUT INTO LOCAL ACTIVITIES, AS WELL AS SERVES AS REPRESENTATION OF HEAltH ACTIVITieS INTO EACH OF THE COMMUNITIES. THE BOARD REPRESENTS MEMBERS FROM THE COMMUNITY THAT ARE NEITHER EMPLOYEES, NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. WRHS EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR ALL OF ITS DEPARTMENTS. WEST RIVER HEALTH SERVICES HAS A POLICY OF USING ANY OF ITS SURPLUS FUNDS FOR IMPROVEMENTS THAT PRoMOTE A HIGHER LEVEL OF QUALITY PATIENT CARE. Part III, Line 2: the footnote to the organization's financial statements can be found on page 11 of the attached financial statements. Part III, Line 3: PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER EVERY EFFORT IS MADE TO COLLECT THE BALANCE AND PATIENTS ARE GIVEN OPPORTUNITIES TO COMPLETE CHARITY CARE APPLICATIONS OR SET UP PAYMENT PLANS. ALL DISCOUNTS AND CONTRACTUAL ADJUSTMENTS ARE APPLIED TO ACCOUNTS BEFORE THEY ARE WRITTEN OFF TO BAD DEBT. CURRENT PAYMENTS ON ACCOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE PROGRAM WAS BASED ON THE PERCENTAGE OF CHARITY CARE TO GROSS CHARGES TIMES THE STATED BAD DEBT EXPENSE. Part III, Line 8: MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. Part III, Line 9b: FOR THOSE PATIENTS THAT RECEIVE DISCOUNTED CARE UNDER THE FAP THE REMAINING SELF-PAY PORTION FALLS UNDER THE SAME COLLECTIONS POLICY AS ALL OTHER PATIENT ACCOUNTS. THE HOSPITAL POLICY IS TO SEND THE UNPAID AMOUNTS TO COLLECTIONS 120 days after the first statement; HOWEVER THE HOSPITAL MAKES ALL EFFORTS TO WORK WITH THE PATIENTS TO COLLECT THE UNPAID AMOUNT BEFORE THEY ACTUALLY SEND IT TO COLLECTIONS. THE PATIENT ACCOUNT MANAGER MAKES SEVERAL ATTEMPTS TO MAKE PAYMENT ARRANGEMENTS THROUGH PHONE CONVERSATIONS AND PERSONAL CONTACT WITH THE PATIENT. Part VI, Line 2: BOARD MEMBERS FROM ALL AFFILIATED BOARDS (WRHSF, WRHS, WHLC) AS WELL AS WRHS MEDICAL STAFF MET TOGETHER AT THE ANNUAL BOARD RETREAT IN JANUARY OF 2015 AT WHICH TIME RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN JULY OF 2014 WERE REVIEWED AND DISCUSSED. THE NEEDS ASSESSMENT SERVED AS THE BASIS FOR HEALTH CARE STRATEGIC AND LONG-RANGE PLANNING TO DEVELOP HEALTHY POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS, AND COLLABORATE WITH OTHER COMMUNITY HEALTH CARE PROVIDERS. THERE IS A WIDE REPRESENTATION FROM ACROSS THE MULTI-COUNTY REGION ON THE WRHS BOARD OF DIRECTORS. BOARD MEMBERS ROUTINELY PROVIDE FEEDBACK TO ADMINISTRATION AND THE BOARD OF PERCEIVED HEALTH CARE NEEDS BASED ON DISCUSSION WITH PATIENTS IN THEIR RESPECTIVE COMMUNITIES. ALTHOUGH ALL MEMBERS OF THE 14-MEMBER PHYSICIAN GROUP WITH WHOM WRHS CONTRACTS FOR PROFESSIONAL MEDICAL SERVICES RESIDE IN HETTINGER, THEY TRAVEL DAILY/WEEKLY TO COMMUNITY CLINICS WITHIN THE REGION. THEY HAVE BECOME ADVOCATES FOR EACH OF THESE COMMUNITIES AND REPRESENT THE COMMUNITY NEEDS TO ADMINISTRATION AND BOARD OF DIRECTORS.WRHS CONDUCTS REGULAR SATISFACTION SURVEYS WITH PATIENTS WHO HAVE RECEIVED HOSPITAL/CLINIC SERVICES FROM WRHS. AS PART OF THOSE SURVEYS, PATIENTS ARE ASKED FOR THEIR INPUT FOR IMPROVEMENT AND/OR TO SUGGEST OTHER NEEDED SERVICES. WRHS FURTHER IDENTITIES UNMET COMMUNITY HEALTH NEEDS BY PARTICIPATING IN COMMUNITY COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, ADVISORY GROUPS, AND PANELS LOCALLY AND WITHIN THE REGION.BASED ON THE ABOVE-NOTED ASSESSMENT MEASURES, THE MAJOR COMMUNITY NEEDS IDENTIFIED FOR 2014 WERE THE NEED TO INCREASE ACCESS TO QUALITY HEALTH CARE, ESPECIALLY FOR CHILDREN, PREGNANT WOMEN, AND UNINSURED ADULTS AND SENIORS; THE NEED TO OBTAIN MEDICAL CARE FOR THE UNDERSERVED BY ENROLLING ELIGIBLE RESIDENTS IN MEDICAID, SCHIP, AND OTHER INSURANCE PROGRAMS; THE NEED TO ENHANCE AND STRENGTHEN MENTAL HEALTH SERVICES WITHIN THE REGION BY RECRUITING ADDITIONAL MENTAL HEALTH PROVIDERS; THE NEED FOR ADDITIONAL ASSISTED LIVING CENTERS; THE NEED TO RECRUIT ADDITIONAL QUALIFIED PHYSICIANS TO THIS UNDERSERVED AREA; THE NEED TO SERVE THE TRANSIENT POPULATIONS AS A RESULT OF THE ECONOMIC BOOM OCCURRING IN NORTH DAKOTA; AND THE NEED TO PROVIDE HEALTH EDUCATION, DISEASE PREVENTION AND CHRONIC DISEASE MANAGEMENT (INCLUDING OBESITY) PROGRAMS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITES SERVED. Part VI, Line 3: IT IS THE MISSION OF WEST RIVER HEALTH SERVICES (WRHS) TO PROVIDE COMPREHENSIVE HEALTH AND WELLNESS SERVICES TO ALL RESIDENTS AND VISITORS IN THE REGION IT SERVES. THESE SERVICES ARE OFFERED TO ALL PATIENTS REGARDLESS OF RACE, COLOR, CREED OR ABILITY TO PAY. WE ARE COMMITTED TO PROVIDE QUALITY HEALTH CARE SERVICES WITH COMPASSION AND RESPECT, PARTICULARLY THE UNDERINSURED AND UNINSURED POPULATION. IT IS THE POLICY OF WRHS TO PROVIDE EFFECTIVE COMMUNICATION WITH PATIENTS REGARDING HOSPITAL BILLS, TO MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS, TO OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS, TO ASSIST LOW-INCOME PATIENTS IN A CONSISTENT MANNER AND TO MAINTAIN FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONS. IT IS NORMALLY AT THE POINT OF ADMISSION THAT THE PATIENT'S ABILITY TO PAY IS ASSSESSED. PATIENTS WHO ARE UNINSURED AND BELIEVED TO HAVE LIMITED RESOURCES ARE REFERRED TO THE WRHS FINANCIAL COUNSELOR WHO WILL DETERMINE PATIENT'S ELIGIBILITY FOR CHARITY CARE AND/OR OTHER FINANCIAL ASSISTANCE PROGRAMS. THE FINANCIAL COUNSELOR WILL ALSO DISCUSS WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENTAL PROGRAMS, INCLUDING MEDICAID OR OTHER STATE-FUNDED PROGRAMS. WHERE APPROPRIATE, THE FINANCIAL COUNSELOR WILL ASSIST THE PATIENT WITH QUALIFICATION AND /OR APPLICATION TO SUCH PROGRAMS.PATIENTS UNABLE TO PAY THEIR MEDICAL BILLS ARE INVITIED TO SUBMIT AN APPLICATION TO THE CHARITY CARE PROGRAM. BOTH THE FINANCIAL COUNSELOR AND THE PATIENT FINCANCIAL SERVICES MANAGER ARE READILY AVAILABLE TO VISIT WITH CANDIDATES TO THIS PROGRAM AND TO ASSIST IN THE APPLICATION PROCESS, AS APPROPRIATE. WRHS INFORMS PATIENTS OF ITS FINANCIAL ASSISTANCE PROGRAMS THROUGH THE WRHS WESITE, BROCHURES AVAiLABLE AT POINTS OF ADMISSION AND THE PATIENT CARE HANDBOOK LOCATED IN EACH PATIENT ROOM. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBLITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE. WRHS HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. WRHS MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. WRHS EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING THOSE WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, CUSTOMER SERVICE, BILLING AND COLLECTIONS) ON THE POLICIES WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. THE FINANCIAL COUNSELOR IS GIVEN MORE IN-DEPTH TRAINING ON HANDLING FINANCIAL ASSISTANCE REQUESTS, PROCESSING OF APPLICATIONS, AND MANAGING OUTCOMES. Part VI, Line 4: HETTINGER IS LOCATED IN SOUTHWESTERN NORTH DAKOTA AND BORDERS THE STATES OF SOUTH DAKOTA AND MONTANA. THE CITY HAS A POPULATION OF 1,236 WITH A TOTAL POPULATION OF 2,384 IN ADAMS COUNTY. IN ADDITION TO THE HOSPITAL AND CLINIC SERVICES LOCATED IN HETTINGER, THERE ARE ALSO RURAL CLINICS LOCATED IN NEW ENGLAND (HETTINGER COUNTY) BOWMAN AND SCRANTON (BOWMAN COUNTY), AND MOTT (HETTINGER COUNTY), ALL IN SOUTHWESTERN NORTH DAKOTA. ANOTHER CLINIC IS LOCATED IN LEMMON, SOUTH DAKOTA (PERKINS COUNTY). IN TOTAL, WEST RIVER HEALTH SERVICS PROVIDES HEALTH CARE TO APPROXIMATELY 13,000 INDIVIDUALS OVER 25,000 SQUARE MILES INCLUSIVE OF THE COUNTIES NAMED. THE MEDIAN HOUSEHOLD INCOME FOR THESE COUNTIES IS $52,991, WHICH IS CONSIDERABLY BELOW THE NORTH DAKOTA AVERAGE OF $57,181.TWENTY-four PERCENT OF THE POPULATION IN ALL COUNTIES SERVED IS 65 YEARS OF AGE OR OLDER. 115 of the population is in poverty. THE NORTH DAKOTA AVERAGE FOR FAMILIES FALLING BELOW POVERTY LEVELS IS also 11%. NOT INCLUDED TO THE ABOVE DEMOGRAPHICS IS THE CITY OF DICKINSON, 75 MILES FROM HETTINGER AND LOCATED IN STARK COUNTY. IT IS HERE THAT WRHS OPERATES A WEEKLY FOOT AND ANKLE CENTER. WITH THE EXCEPTION OF DICKINSON, ALL OTHER SITES HAVE BEEN DESIGNATED AS MEDICALLY UNDERSERVED AREAS. HEALTH CARE IS AN IMPORTANT PART OF THE ECONOMY AND, AS SUCH, THE HOSPITAL AND CLINICS HAVE BECOME ONE OF THE TOP EMPLOYERS IN THE REGION. THERE IS ANOTHER HOSPITAL AND CLINIC IN BOWMAN, LOCATED 40 MILES WEST OF HETTINGER. THERE IS ALSO A HOSPITAL AND SEVERAL OTHER CLINICS IN DICKINSON, LOCATED 75 MILES NORTHWEST OF HETTINGER. TERTIARY REFERRAL CENTERS ARE LOCATED 150 MILES AWAY IN BISMARCK, NORTH DAKOTA, AND 180 MILES AWAY IN RAPID CITY, SOUTH DAKOTA. Part VI, Line 5: THE ORGANIZATION HAS LONG BEEN A PROMOTER OF MEDICAL EDUCATION AND HAS ENJOYED A LONGSTANDING RELATIONSHIP WITH THE UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE IN PROVIDING ROTATION SITES FOR MEDICAL STUDENTS. PHYSICIANS WITHIN THE ORGNAIZATION GRACIOUSLY PRECEPTOR THESE STUDENTS. WITH THE SUPPORT, ENDORSEMNT, AND APPROVAL OF UND'S ADVISORY COUNCIL, THE STATE BOARD OF HIGHER EDUCATION, AND THE UND SCHOOL OF MEDICINE AND HEALTH SCIENCES, THE NORTH DAKOTA STATE LEGISLATURE APPROVED THE INITAL FUNDING FOR AN EXPANSION OF GRADUATE MEDICAL EDUCATION RESIDENCIES WITH THE STATE. WEST RIVER REGIONAL MEDICAL CENTER OF HETTINGER WAS INCLUDED TO THE FUNDING PROPOSAL AND is partnering WITH THE BISMARCK CENTER FOR FAMILY MEDICINE TO OFFER RESIDENCIES TO YEAR TWO AND THREE RESIDENTS IN A RURAL SETTING. THIS IS A COLLBORATIVE EFFORT BETWEEN ALL ENTITIES TO ENSURE AN ADEQUATE SUPPLY OF PROFESSIONALS FOR THE FUTURE, ESPECIALLY PRIMARY CARE PROVIDERS AND PARTICULARLY TO RURAL AREAS. IN ADDITION TO TOTAL UNCOMPENSATED CARE FOR FY '16 OF $780,380, WRHS ALSO PROVIDES MANY OTHER SERVICES AS IN-KIND SUPPORT TO BENEFIT THE HEALTH OF THE COMMUNITIES AND REGIONS IT SERVES. THESE COMMUNITY BENEFITS INCLUDE OFFERING CPR AND FIRST AID PROGRAMS TO THE GENERAL PUBLIC, GUIDING TOURS OF THE HOSPITAL/CLINIC TO AREA SCHOOL CHILDREN, PROVIDING HEALTH AND WELLNESS EDUCATION CLASSES TO THE PUBLIC AND EDUCATING/TRAINING PARAMEDICS/EMTS IN ALL OUTREACH COMMUNITIES.HETTINGER HAS A LOCALLY-OWNED RADIO STATION. THIS STATION HAS A PROGRAM CALLED TTO (THIS, THAT, AND OTHER THINGS). THIS PROGRAM AIRS DAILY (M-F). WRHS HAS A DESIGNATED TWO HOURS PER MONTH TO SHARE INFORMATION ABOUT HEALTHY HAPPENINGS AND PROMOTE GENERAL HEALTH AND WELL-BEING. WRHS COSTS SHOWN WERE STAFF TIME TO PREPARE AND PARTICIPATE IN THE TALK SHOW.TWO EMPLOYEES OF WRHS ANNUALLY TEACH FOURTH, FIFTH, AND SIXTH GRADERS AT THE PUBLIC SCHOOL ABOUT PUBERTY AND ITS CHANGES FOR BOTH BOYS AND GIRLS. HYGIENE, HORMONAL CHANGES, AND BODY DEVELOPMENT PHASES ARE A MAJOR PART OF THIS CURRICULUM.WEST RIVER HEALTH SERVICES AND CLINICS IT OPERATES ARE LOCATED IN A VERY SPARSELY POPULATED RURAL AREA. TRANSPORTATION FOR SENIORS TO/FROM CLINIC APPOINTMENTS IS DIFFICULT AND EXPENSIVE. MANY SENIORS OFTEN OPT TO NOT COME FOR THEIR APPOINTMENT IN LIGHT OF THE COST AND INCONVENIENCE OF GETTING TO THE CLINIC. RECOGNIZING THE IMPORTANCE OF THESE PATIENTS TO KEEP THEIR APPOINTMENTS AND MAINTAIN OPTIMAL HEALTH, WRHS IS SHARING IN THE COST FOR SENIORS TO TRAVEL TO/FROM CLINICS. LOCALLY-ESTABLISHED SENIOR VANS ARE USED FOR THIS SERVICE AND WRHS REIMBURSES ONE-HALF THE COST OF THE TRANSPORTATION IN GETTING PATIENTS TO/FROM CLINIC AND/OR HOSPITAL SERVICES. FOR MORE INFORMATION ABOUT WRHS, VISIT WWW.WRHS.COM. X X X 0 0 0 0 0 0 0 0 0 JIM LONG CEO (Former) 163523 0 0 0 0 0 6000 0 15400 0 184923 0 0 0 A city of hettinger north dakota 456002094 noneavail 2008-01-31 5275000 EXPAND AND RENOVATE HOSPITAL 0 0 0 A 895181 5275000 105500 5169500 2010 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 Schedule K, Part IV, Line 2 West river health services has determined that a rebate computation was not warranted due to the tax exempt bond being a draw down bond that did not have invested proceeds. All funds were spent within the allotted time period. JENIFER LONG SPOUSE OF JIM LONG, CEO 42696 COMPENSATION 0 KYLEE STADHEIM SPOUSE OF NATHAN STADHEIM, CFO 11944 COMPENSATION 0 LANI SCHULTZ SPOUSE OF MITCH SCHULTZ 53235 COMPENSATION 0 TARA JORGENSON SPOUSE OF CODY JORGENSON, DIRECTOR 70064 COMPENSATION 0 Form 990, Part VI, Section A, line 1 THERE IS AN EXECUTIVE COMMITTEE THAT HAS AUTHORITY TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS. MINUTES OF THE EXECUTIVE COMMITTEE SHALL BE SUBMITTED TO THE BOARD AND ITS ACTION SHALL BE SUBJECT TO THE APPROVAL OR DISAPPROVAL AT THE NEXT REGULAR BOARD MEETING. THIS COMMITTEE WILL MEET WHEN CALLED BY THE CHAIRMAN. THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIRMAN, VICE CHAIR, SECRETARY/TREASURER, PAST CHAIRMAN, MEDICAL STAFF REPRESENTATIVE OF THE BOARD, AND TWO OTHER BOARD MEMBERS. Form 990, Part VI, Section A, line 6 WEST RIVER HEALTH SERVICES FOUNDATION IS THE SOLE MEMBER OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7a AS THE SOLE MEMBER, WRHS FOUNDATION APPOINTS THE BOARD MEMBERS OF WRHS. Form 990, Part VI, Section A, line 7b AS A SOLE MEMBER, WRHS FOUNDATION APPROVES ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS, DETERMINES APPROVED DEBT LEVELS AND APPROVES INDIVIDUAL DEBT TRANSACTIONS THAT EXCEED THE APPROVED DEBT LEVELS, APPROVES DISSOLUTION OR MERGER OF THE ORGANIZATION, AND APPROVES THE SALE OR TRANSFER OF ANY CAPITAL ASSETS HAVING A PURCHASE PRICE OR MARKET VALUE GREATER THAN $100,000. Form 990, Part VI, Section B, line 11 THE CFO AND CEO WILL REVIEW THE FORM 990 PRIOR TO THE COMPLETED FORM 990 BEING DISTRIBUTED ELECTRONICALLY TO THE BOARD MEMBERS FOR THEIR REVIEW AND COMMENTS. THE FORM 990 IS ALSO REVIEWED AND DISCUSSED AT A BOARD MEETING. Form 990, Part VI, Section B, line 12c ALL MEDICAL STAFF, EMPLOYEES, AND BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS. POTENTIAL CONFLICTS ARE REVIEWED BY THE CEO. INDIVIDUALS WITH CONFLICTS ABSTAIN FROM VOTING, AND THIS ACTION IS NOTED BY BOARD MINUTES. Form 990, Part VI, Section B, line 15a CEO: EACH BOARD AND MEDICAL STAFF MEMBER ANNUALLY COMPLETE AN EVALUATION FORM ON THE CEO'S PERFORMANCE. THE CHAIRMAN OF EXECUTIVE COMMITTEE TABULATES THE RESULTS AND REVIEWS THEM WITH THE OTHER MEMBERS OF THE EXECUTIVE COMMITTEE. THE RESULTS ARE PRESENTED TO THE FULL BOARD OF DIRECTORS WHO HAVE FINAL AUTHORITY IN DETERMINING COMPENSATION. COMPARABILITY DATA FROM THE STATE HOSPITAL ASSOCIATION, AS WELL AS OTHER COMPARATIVE INDUSTRY INFORMATION, IS USED IN DETERMINING COMPENSATION. CFO: THE CEO REVIEWS THE CFO'S PERFORMANCE AND USES COMPARABILITY DATA IN DETERMINING COMPENSATION. ALL OTHER EMPLOYEES: THE ADMINISTRATIVE STAFF USES COMPARABLE DATA IN SETTING COMPENSATION FOR EACH LEVEL OF EMPLOYEE. COMPENSATION IS REVIEWED ANNUALLY. Form 990, Part VI, Section C, line 19 ADMINISTRATIVE REPRESENTATIVES OF THE ORGANIZATION WILL PROVIDE THE GOVERNING BOARD DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS UPON WRITTEN OR VERBAL REQUEST TO ADMINISTRATIVE REPRESENTATIVES OF THE ORGANIZATION. Form 990, Part IX, line 11g PURCHASED SERVICES: Program service expenses 6,484,874. Management and general expenses 196,414. Fundraising expenses 0. Total expenses 6,681,288. Form 990, Part XII, Line 2c: THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. WESTERN HORIZONS LIVING CENTER 1104 HIGHWAY 12 HETTINGER SD 58369 260794602 LONG-TERM CARE/ASSISTED LIVING FACILITY ND 501C LINE 9 WEST RIVER HEALTH SERVICES FOUNDATION 0 WEST RIVER HEALTH SERVICES FOUNDATION 1000 HIGHWAY 12 HETTINGER SD 58369 450411825 FUNDRAISING ND 501C LINE 11C, III-F1 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 WEST RIVER HEALTH SERVICES FOUNDATION C 536683 CASH PAID WEST RIVER HEALTH SERVICES FOUNDATION D 3669 CASH PAID WESTERN HORIZONS LIVING CENTER D 261102 CASH PAID WEST RIVER HEALTH SERVICES FOUNDATION O 1564614 CASH PAID WESTERN HORIZONS LIVING CENTER J 99775 LEASE AGREEMENT WEST RIVER HEALTH SERVICES FOUNDATION Q 128522 cash PAID WESTERN HORIZONS LIVING CENTER Q 68938 CASH PAID